The CAI LARC Modeling Tool may be helpful to providers who do not currently offer LARC methods out of a concern that available reimbursements would result in a financial loss to a practice. This tool uses information about a practice’s estimated LARC demand, payer mix, and reimbursement rates to explore the costs associated with provision of each LARC method. It may also help identify payers with anomalously low reimbursement rates and provide information useful in future contract negotiations. Efficacy and patient satisfaction rates for LARC methods can also be useful during discussions with third-party payers to negotiate increases in reimbursement rates.
Providers experience decreased reimbursement rates for Mirena LNG-IUS devices due to reimbursement adjustments in the market may be eligible for loss-offsetting rebates from the manufacturer. To be eligible for a rebate:
- The device was purchased sometime between April 1, 2015 and June 30,2015.
- The device was used on a date of services between July 1, 2015 and December 31, 2015.
- The payer responsible for reimbursement of the device has reduced its reimbursement rate for HCPCS code J7302, which resulted in a payment at less than the provider's net acquisition cost.
Providers should refer to the Mirena Rebate Program policy for more information on submitting a rebate request.